Exclusive Breastfeeding: Barrier analysis amongst Omani mothers.

Objectives: This study aimed to examine individual barriers and supports to exclusive breastfeeding (EBF) and identify potential policy and programmatic interventions in Oman, where less than a quarter of Omani infants under six months are exclusively breastfed. Methods: A cross-sectional barrier analysis (BA) was carried out among a purposive sample of Omani women who were selected and interviewed by trained enumerators in health clinics in various parts of the country. A BA tool, adapted for the Omani context, covered 12 common determinants of behaviour adoption using open-ended questions regarding participants' perceptions about EBF including positive and negative consequences, self-efficacy and social norms. Qualitative analysis involved coding and tabulating as well as thematic analysis. Results: This study included a total of 45 'doers' (who exclusively breastfed their infants) and 52 'non-doers' (who did not). Mothers reported that motivations for EBF include the perception that it leads to healthier children and is easy to do, readily available and therefore convenient, as well as that there is an high level of family support for breastfeeding. Barriers included perceived milk insufficiency and mother's employment. Conclusion: To achieve the EBF target of 50% for 2025, public health action should focus on emphasising the benefits and convenience of EBF and building women's confidence in their ability to produce sufficient milk. These efforts will require increasing the knowledge and skills of community and healthcare workers and establishing monitoring mechanisms. Extended paid maternity leave and supportive workplace policies are necessary to encourage working women to exclusively breastfeed.

Rapid assessment of marketing of unhealthy foods to children in mass media, schools and retail stores in Oman.

BACKGROUND: The prevalence of overweight and obesity is high in the Eastern Mediterranean Region. Half of the Region's adult women (50.1%) and more than two in five men (43.8%) are overweight or obese, and 6.9% of children aged under five years in the Region are already overweight, which is higher than the global average of 6.2%. AIMS: This rapid assessment aimed to examine marketing techniques of foods and non-alcoholic beverages targeting children and assessed implementation of food restrictions in schools as part of the national effort to address obesity in Oman. METHODS: Trained reviewers assessed Arabic TV satellite stations, local radio and print media, a random sample of schools, and a convenience sample of grocery stores, cafes and convenience stores between November 2015 and October 2016. RESULTS: A majority of TV advertisements (71%) were for follow-up milk formula and used a variety of methods to attract children. A large portion of radio advertisements (44%) were for savoury snacks; all included children and used sounds/words to attract children. Few print media advertisements promoted snacks; however, a large majority of the sugary snack advertisements (13% of print media) used pictures/words and incentives (awards) to attract children. In schools, most beverages purchased by children had added sugars. CONCLUSIONS: Establishing a comprehensive regulatory framework under the national Child Law and the Convention of the Rights of the Child should be complemented by systematic monitoring of their impact on child health, and increasing food and beverage literacy among principals, teachers, canteen managers and the wider community.

Physical fitness characteristics of Omani primary school children according to body mass index.

BACKGROUND: There is evidence that children with high cardiorespiratory fitness and normal body mass index (BMI) have less risk of non-communicable diseases (NCDs), however limited research was undertaken in Omani children. Therefore the aims of the present study were to describe body composition and physical fitness of a large cohort of Omani school children of both genders, and to investigate the effects of weight status on physical fitness. METHODS: Three hundred and fourteen Omani school children aged 9 to 10 years old took part in anthropometric assessments, body composition and fitness tests, including handgrip strength, the basketball chest pass, broad jump, 20-m sprint, four 10-m shuttle agility, 30-s sit-up, and multistage fitness test (MSFT). RESULTS: Obese boys and girls performed worse than normal-weight children in sprint, agility and endurance. In addition, fitness measures in the overweight group and underweight groups were not significantly different from other groups, except a better handgrip strength and poorer MSFT in overweight compared to normal weight girls, and poorer agility performance in underweight girls compared to the three other groups. CONCLUSIONS: Most fitness measures are lower in obese Omani children, which suggests that they will be more at risk of developing NCDs later in life.

Randomized open-label trial of docosahexaenoic acid-enriched fish oil and fish meal on cognitive and behavioral functioning in Omani children.

OBJECTIVE: This study aimed to examine the effect of docosahexaenoic acid (DHA)-enriched fish oil supplement and meal of grilled fish on cognitive and behavioral functioning manifested as attention-deficit/hyperactivity disorder in primary school students 9 to 10 y of age in Muscat, Oman. METHODS: This randomized open-label trial involved two types of interventions: fish oil supplement or one serving (100 g) of grilled fish per day (Sunday through Friday) for 12 weeks. Red cell total lipid DHA levels were assessed. The Verbal Fluency Test, Buschke Selective Reminding Test, and Trail Making Test were used to measure cognitive functioning. Behavioral functioning was assessed using a standardized Arabic version of the National Initiative for Children's Health Quality Vanderbilt Assessment Scales. All measurements were carried out before and after intervention. RESULTS: DHA levels increased by 72% and 64% in the fish oil (mean, 3.6%-6.2%) and fish-meal (mean, 3.4%-5.6%) groups, respectively (P = 0.000). The Trail Making Test was the only cognitive test that demonstrated marked differences between groups: Median interquartile range difference between pre- and postintervention in the Trail Making Part B score was 61.5 (SE, 19.3, 103.2) in the fish oil versus fish-meal group, 24.5 (SE, -15.2, 74.7, P = 0.005). The Vanderbilt Assessment Scales also showed significant differences between groups (P < 0.001). CONCLUSION: This study contributed to available evidence on the cognitive and behavioral benefits of DHA in healthy school children. Expanding the food fortification program with DHA-enriched fish oil should be considered as part of broader policy to improve child health.

Attention Deficit Hyperactivity Disorder and Parental Factors in School Children Aged Nine to Ten Years in Muscat, Oman.

OBJECTIVES: The objectives of this study were to determine the prevalence of attention deficit hyperactivity disorder (ADHD) and specific parental risk factors that may contribute to the development of ADHD in children. METHODS: The study was conducted in Oman among fourth-grade students (aged nine to 10 years). A standardized Arabic version of the National Initiative for Children's Health Quality Vanderbilt Assessment Scale (Teachers questionnaire) was used to determine the presence of ADHD. Parental factors such as socioeconomic status, education, and occupation were documented. RESULTS: The prevalence rate of ADHD was 8.8%. Poor maternal education status, low familial socioeconomic status, and paternal occupation were significantly associated with an increased risk of ADHD. CONCLUSIONS: This was the first study that examined familial and parental characteristics of children with ADHD as potential risk factors for the condition. Such psychosocial factors could be employed to further the development of more proficient preventative measures and remedial services.

Estimation of the Prevalence of Inadequate and Excessive Iodine Intakes in School-Age Children from the Adjusted Distribution of Urinary Iodine Concentrations from Population Surveys.

BACKGROUND: The urinary iodine concentration (UIC), a biomarker of iodine intake, is used to assess population iodine status by deriving the median UIC, but this does not quantify the percentage of individuals with habitually deficient or excess iodine intakes. Individuals with a UIC <100 µg/L or ≥300 µg/L are often incorrectly classified as having deficient or excess intakes, but this likely overestimates the true prevalence. OBJECTIVE: Our aim was to estimate the prevalence of inadequate and excess iodine intake in children (aged 4-14 y) with the distribution of spot UIC from iodine surveys. METHODS: With the use of data from national iodine studies (Kuwait, Oman, Thailand, and Qatar) and a regional study (China) in children (n = 6117) in which a repeat UIC was obtained in a subsample (n = 1060), we calculated daily iodine intake from spot UICs from the relation between body weight and 24-h urine volume and within-person variation by using the repeat UIC. We also estimated pooled external within-person proportion of total variances by region. We used within-person variance proportions to obtain the prevalence of inadequate or excess usual iodine intake by using the Estimated Average Requirement (EAR)/Tolerable Upper Intake Level (UL) cutoff method. RESULTS: Median UICs in Kuwait, Oman, China, Thailand, and Qatar were 132, 192, 199, 262, and 333 µg/L, respectively. Internal within-person variance proportions ranged from 25.0% to 80.0%, and pooled regional external estimates ranged from 40.4% to 77.5%. The prevalence of inadequate and excess intakes as defined by the adjusted EAR/UL cutoff method was ∼45-99% lower than those defined by a spot UIC <100 µg/L or ≥300 µg/L (P < 0.01). CONCLUSIONS: Applying the EAR/UL cutoff method to iodine intakes from adjusted UIC distributions is a promising approach to estimate the number of individuals with deficient or excess iodine intakes.

Lipid-soluble nutrient status of healthy Omani school children before and after intervention with oily fish meal or re-esterified triacylglycerol fish oil.

OBJECTIVES: Over the past two decades, the Omani diet has changed considerably to resemble a high calorie and a low nutrient density Western diet. We investigated the fat soluble nutrient status of children before and after intervention with fish diet or fish oil. METHODS: Children ages 9 and 10 y (n = 314) were recruited from three randomly selected schools. The schools were assigned to a fish, fish oil, or control group and the children were given a lightly grilled oily fish, a re-esterified triacylglycerol fish oil capsule, or no fish for 12 wk. RESULTS: Plasma vitamin A, beta carotene, vitamin E concentrations, and vitamin E/total lipid ratio at baseline were 2.7 ± 0.85 µmol/L, 0.68 ± 0.48 µmol/L, 21.1 ± 4.8 µmol/L, and 5.0 ± 0.81 µmol/mmol, respectively, and none of the children were deficient. They were severely deficient (<27.5 nmol/L; 10.5% boys and 28.5% girls), deficient (27.5-44.9 nmol/L; 47.6% boys and 49.4% girls) or insufficient (50-74.9 nmol/L; 34.6% boys and 21.5% girls) in vitamin D; only 7.3% boys and 0.6% girls had optimal status (≥75 nmol/L). Parathyroid hormone (5.0 ± 1.7 versus 5.8 ± 2.1 pmol/L; P < 0.0001) and alkaline phosphatase (225.2 ± 66.6 versus 247.8 ± 73.7 U/L; P < 0.01) levels were lower in boys. Postintervention, the fish oil (54.1 ± 17.5 nmol/L; P < 0.001) and fish (49.2 ± 17.4 nmol/L; P < 0.05) groups had elevated levels of vitamin D compared with the controls (42.3 ± 17.5 nmol/L). CONCLUSIONS: Vitamin D deficiency is prevalent in Omani school children, but it can be mitigated with omega-3 fatty acid supplementation. Vitamin D plays a crucial role in skeletal and extraskeletal systems. Hence, there is a need for a child-focused program of food fortification and outdoor activities to alleviate the problem.